What are Bundled Procedures?
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Bundled procedures, also known as global surgical packages, are sets of related medical services and procedures that are grouped together and billed as a single comprehensive service. In the context of surgical coding, this means that certain services and follow-up care related to a specific surgical procedure are considered inclusive or bundled within the primary surgical procedure code. These bundled services are not separately billed or reimbursed.
The global surgical package includes three main phases of care:
1. Pre-operative Care: This phase covers services provided to the patient before the surgery takes place. It typically includes all necessary evaluations, consultations, and tests conducted to prepare the patient for the surgery. It may also include the initial visit to diagnose the condition requiring surgery.
2. Intra-operative Care: This phase covers the actual surgery or procedure performed on the patient. It includes the procedure itself, anesthesia administration (if applicable), and any other services directly related to the surgery, such as surgical supplies and operating room expenses.
3. Post-operative Care: This phase covers the period immediately after the surgery, during which the patient receives routine post-operative care and follow-up visits. It typically includes follow-up visits during the global period, which is a specified number of days assigned to each surgical procedure for post-operative care. The global period can vary depending on the complexity of the procedure and the standard of care for that specific surgery.
During the global period, any routine follow-up visits related to the surgery and minor procedures required for the patient's post-operative care are considered part of the bundled service. Additionally, any treatment of complications directly related to the surgery is included in the global surgical package.
For example, let's say a patient undergoes a knee arthroscopy, and the CPT code for this procedure is 29881. The global surgical package for CPT code 29881 might include pre-operative consultations, the arthroscopic procedure itself, and any routine post-operative visits for a specified number of days, typically 10, 90, or 0 days depending on the complexity of the procedure.
It is important for medical coders and healthcare providers to be aware of the global surgical periods associated with each specific CPT code. They should not separately bill for any services included in the global surgical package during the designated postoperative period. However, if the patient requires additional unrelated services or treatment during the global period, these services may be billed and coded separately.
Each payer (e.g., Medicare, and private insurance companies) may have specific guidelines and policies regarding global surgical packages, so it is essential to review individual payer rules to ensure compliance with their billing requirements.
